Overtreatment and unnecessary medical testing? You make the call!

Ok, readers. I know how many of you fantasize about being part of the high drama and glamour of the medical profession. Believe me, it's even more exciting than the medical TV shows that have been part of pop culture for generations. Remember Ben Casey? Marcus Welby? Dr. Kildare? Dr. Seuss? Rescuing folks hovering over the Grim Reaper was just another day at work for these guys.

Here's your chance to play doctor for the duration of this post.

A patient wants a colonoscopy, but it is not medically necessary. Assuming he cannot be convinced to withdraw the request, should you perform it?

A physician wants you to perform colonoscopy on his patient, but it is not medically necessary. Assuming the physician cannot be convinced to withdraw the request, should you perform it?

An elderly patient's son wants a colonoscopy performed on his father, but it is not medically necessary. The patient is ambivalent and delegates the decision to his son. Assuming the son cannot be convinced to withdraw the request, should you perform it?

A nursing home requests that a feeding tube be placed on an elderly resident. While the tube would be much more convenient for the staff with regard to administering food and medication, the tube could be avoided if a staff member had sufficient time to assist the patient with meals and medicines. Should you place the feeding tube?

An anxious mom (please forgive the sexism here) demands an antibiotic for her child's sore throat, which is not medically necessary. Assuming she cannot be dissuaded from her request, reinforced by prior physicians who prescribed antibiotics under similar circumstances, should you acquiesce?

A man is critically ill in the intensive care unit and is nearing the afterlife. The consensus among the treating physicians is that additional care would be medically futile. There is no advanced directive or medical power of attorney. The next of kin insists that the patient be placed on life support. He is not persuaded to withdraw his demand and suggests that there would be consequences if his relative is simply allowed to die. What would you do here?

So, “doctors”, any thoughts?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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